Managing Your Allergies
Customized treatments offer relief from chronic sneezing, sniffling, congestion and watery eyes.
When I started taking a strong prescription antihistamine at age 7 so I could play in the grass without sneezing and erupting in hives, my pediatrician told me that I’d probably outgrow my seasonal allergies by the time I started high school.
Thirteen years later, I was still taking that antihistamine — while still avoiding contact with grass because the drug only lessened my allergic reactions. So when
I heard that an eminent Scottish immunologist was conducting a study of a new allergy prevention therapy on my college campus, I lost no time applying to participate. After interviewing me about my symptoms, though, the doctor scolded me for being a “typical spoiled American” who popped pills at the slightest discomfort. I should manage my allergies with over-the-counter medications and leave the prescription drugs and the immunotherapy to people with “real allergy problems.” Unfortunately, I was so entranced by the lilt of his Highland accent that I’d left his office before it dawned on me that I had just been insulted.
These days, allergists both at home and abroad are offering a wide range of therapies to people with all types of allergies, from mild cold-like congestion during ragweed season to debilitating year-round dust and mold allergies, to life-threatening food allergies.
“There is no reason for a patient to suffer from allergies,” asserts Dr. Diane Ozog of Ozog & Associates, with clinics in Lombard and Naperville. “There are so many options out there now that you can customize a treatment regime to fit any patient’s allergies.”
That’s especially good news because the number of people with environmental allergies has climbed steadily, from about 35 million in 1990 to more than 50 million in 2015, according to the American College of Allergy, Asthma and Immunology. Add the estimated 15 million people who have food or drug allergies, which is almost twice the 8 million estimated in 1990, and the total comes out to 65 million — about 20 percent of the 319 million people living in the U.S.
What causes allergies in the first place? For most people, the process starts with an inherited tendency to develop antibodies that treat harmless particles like pollen, cat dander or dust-like dangerous germs. A child with one allergy-prone parent has a 33 percent higher risk of developing allergies than a child without a family history of allergies. For a child with two allergy-prone parents, that extra risk shoots up to 70 percent.
When the immune system decides that a substance represents a threat, it maps the invader and designs antibodies that recognize it, cling to it and activates the body’s defense system upon contact, explains Dr. Jacqueline Moran of DuPage Medical Group. The next time that person inhales or ingests the same substance, the antibodies spring into action and the person experiences the same unpleasant side effects that he or she would get while fighting off a true infection.
Ironically, the same mass immunizations that have virtually wiped out life-threatening diseases like measles, smallpox and diphtheria could be contributing to the increase of allergy sufferers in the U.S. “When we’re children, our immune systems don’t have any serious diseases to fight anymore,” Moran notes. “One theory about the rise in allergies is that during childhood, when the immune system is at its peak efficiency to identify germs and create antibodies for them, it develops antibodies to protect against harmless foreign particles instead because it doesn’t have enough diseases to keep it busy.”
Another factor is that many babies and toddlers are quarantined from dirt, plants and other natural parts of the environment by parents anxious to protect them from germs. Since the immune system isn’t acquainted with these substances before its antibody-generating function reaches full strength, it assumes later on that they’re dangerous and defends the body against them.
“Clean is not always a good thing,” maintains Dr. Rachna Shah, a professor at Loyola University’s School of Medicine and a partner in Allergy, Sinus and Asthma Professionals clinic, with locations in Melrose Park, Oak Park and Elmhurst. “I tell new mothers to let their babies play in the dirt so they can exercise
their immune systems and avoid getting allergies later on,” says Shah, adding that growing up on a farm lowers a person’s risk of developing allergies, as does growing up from infancy with a dog, cat or other furry pet.
So why do many adults suddenly find themselves sneezing and wheezing every spring or fall after decades of living blissfully allergy-free lives?
“We have a lot of people come to us because they moved to the Naperville area from other parts of the country and then developed allergies,” Moran states. “Either they developed a childhood allergy, moved away from the source of that allergy, and then years later moved somewhere where it grows, or their previous environment was so different than this one that their immune systems are developing new allergies to substances that are strange to them.”
People can develop new allergies or “outgrow” old allergies at any point in their lives, adds Dr. Ronald Wolfson of Allergy & Asthma Clinic of Fox Valley, with locations in Geneva and Aurora. “The immune system can get quirky, and nobody really understands why,” he says. In particular, women undergoing major hormone shifts associated with pregnancy and menopause often “reset” their allergy threshholds, with about one-third of them losing or lessening their allergies, one-third seeing their allergies worsen, and one-third settling back into their original allergic response patterns, Ozog explains.
It’s tempting to just put up with the sneezing, stuffy nose and itchy eyes rather than spend time and money in a doctor’s office, especially for a seasonal allergy
that only lasts one or two months each year. But allergies can contribute to other health problems, some of them potentially fatal, warns otolaryngologist Dr. Samuel Girgis of Drs. Girgis & Associates in Hinsdale, Oak Park and La Grange.
“Untreated allergies can cause swelling of the inner ear, which in turn causes dizziness and balance problems,” notes Girgis. “They can also disrupt patients’ sleep and impair their hearing.” Dizziness can make patients fall — especially elderly people — while lack of sleep and impaired hearing reduce people’s ability to safely drive or use machinery.
Allergies can even instigate laryngopharyngeal reflux, a gastric condition that affects speaking, breathing and sleep. “One of the main causes of sinus congestion is silent reflux,” Girgis explains. “Swallowed mucus and increased coughing bring up small quantities of stomach acid — just a few drops at a
time. The acid hangs up on the arytenoid cartilage (at the back of the throat, next to the vocal cords), which makes the vocal cords swell and collect more mucus. The patient feels like there’s a lump in the back of his throat, so he tries to swallow and clear his throat, which just makes the irritation worse.”
Eating nothing within three hours of bedtime, limiting dairy products to less than 12 ounces per day, and drinking at least 48 ounces of water daily helps
the body produce thinner mucus, which breaks the silent reflux cycle, he advises.
Despite the many allergy-fighting medications available, allergen avoidance remains the first line of defense for most sufferers. “Even the mildest over-the-counter antihistamine can have a sedative effect on some people,” says Wolfson. “I’m very reluctant to put young or active people on antihistamines if avoidance can solve their allergy problems.”
Avoidance can be as simple as staying indoors as much as possible between 6 a.m. and 10 a.m., when most flowering plants release their pollen into the air, or
as complex as moving to a desert area like Arizona to get away from flowering plants entirely. In between those extremes are many helpful tactics, such as dusting; vacuuming and changing bed linens more frequently to remove accumulated dust and pollen; using a High Efficiency Particulate Arrestance (HEPA) furnace/air conditioning filter instead of a standard filter; showering at bedtime to wash off accumulated pollen; and making sure allergy triggers aren’t lurking in your landscaping.
“When we first moved here, my 10-year-old daughter’s allergies just exploded,” recalls “Julia”, a mother of two in the Fox Valley. “She’d always had hay fever, but it was mostly from ragweed and Timothy weed, and neither of those were growing in our neighborhood. Then I found a gardening book that listed common plants by their pollen count, and I found out that a lovely silver-leafed plant called dusty miller that was planted all around our house was really high on the list. So we pulled it all up, and my daughter’s allergies went back to normal.”
Morton Arboretum docents recommend Allergy-Free Gardening: The Revolutionary Guide to Healthy Landscaping by Thomas Leo Ogren as a good source for Midwest homeowners looking to make their landscaping more hypoallergenic.
When it’s impossible to avoid allergens completely, a sinus rinse can reduce a patient’s dependence on antihistamines, says Ozog. Practiced for thousands
of years in southeast Asia, pouring or squirting small amounts of clean water through the nostrils into the sinus cavities immediately surrounding the nose rinses away trapped particles and reduces allergy-induced swelling.
“It sounds complicated, but it’s really very easy to do,” says Ozog. “It’s especially useful to help very young children who should be taking as little antihistamine
as possible. You’d be amazed by how many of my pediatric patients love it.” Patients — or their parents — can buy traditional Hindu neti pots at most health food stores, or just use a small squeeze bottle to get the water into their sinuses.
In the past 20 years, most antihistamines have become available over the counter, though some also come in stronger doses that are available only by prescription. While many first-generation antihistamines have been supplanted by newer drugs with fewer side effects, a couple which are still popular today in non-prescription strength are chlorpheniramine maleate, marketed as Chlor-Trimeton, and diphenhydramine, marketed as Benadryl. Second-generation antihistamines include fexofenadrine (Allegra); loratidine (Claritin); and certirizine (Zyrtec). Most people try several different types of antihistamine before finding the one that works best with their individual immune systems, doctors agree.
In the past few years, manufacturers have introduced third-generation versions of current medications, such as desloratidine (Clarinex) and levocertirizine (Xyzal). They induce less drowsiness than even their second-generation counterparts and are safer for infants and preschoolers, as well as for adults whose occupations involve driving or operating heavy equipment, Ozog says. They are currently not available over the counter.
While nasal sprays don’t block the body’s histamine response to allergens, they do help relieve histamine-induced swelling, which in turn reduces congestion and that distracting “stuffed-up” feeling, Moran advises.
Patients whose allergies affect their ability to function despite avoidance and antihistamines can move up to therapies designed to desensitize the immune system to allergen triggers. “You can’t have allergies without antibodies,” Wolfson explains. “Therefore, if you retrain the immune system to stop producing antibodies to the allergens, you’ve cured the allergy.”
Doctors perform that retraining by injecting trace amounts of whatever the patient is allergic to into the patient’s bloodstream once a week for between six and twelve months, increasing the allergen dosage each time until the patient can tolerate doses equal to the maximum exposure they would get in their environment. After the initial treatment, patients come back every three months for booster shots to maintain their newly gained allergic immunity for about four years, at which point most people no longer need even the maintenance doses.
“I never tell patients that the shots are a permanent cure,” says Moran. “Sometimes people need to take the maintenance shots indefinitely, and sometimes allergies can recur. But immunotherapy has helped millions of people live comfortably without medications, so for people with serious allergies it’s a proven treatment.”
New treatment options, like antihistamine patches and long-lasting seasonal allergy pills that dissolve under the tongue without needing to be swallowed, are starting to hit the marketplace now, while researchers are close to perfecting ways to synthesize allergens to make immunotherapy more effective, Shah observes.
“There’s a lot of cool stuff in the pipeline that’s undergoing Stage 2 or Stage 3 testing for Food and Drug Administration approval,” says Shah. “The next few years could see some dramatic improvements for allergy sufferers.”
Addressing the Dangers of Food Allergies
Science still has no way to let someone with a peanut allergy safely eat a jar of Jif. But medical researchers are testing ways to keep an accidental taste from being lethal.
“There have been a lot of studies on oral desensitization using peanut proteins,” says allergist Dr. Rachna Shah, a professor at Loyola University’s School of Medicine and a partner in Allergy, Sinus and Asthma Professionals clinic, with locations in Melrose Park, Oak Park and Elmhurst. “At first it’s very risky, but over time some test subjects have been desensitized enough that they no longer have to fear for their lives if they come into contact with peanuts.”
Food allergies start the same way respiratory allergies do. Once the immune system mistakenly identifies an ingested substance as an invasive threat, it develops antibodies that trigger the body’s defense mechanisms against that substance. What makes most food allergies more dangerous than respiratory allergies is that the allergen goes straight to the bloodstream, which intensifies the immune response, explains Dr. Diane Ozog of Ozog & Associates clinics in Lombard and Naperville.
Anaphylactic shock happens when the body shuts down its own airways and blood circulation to keep the perceived threat from getting to the brain. While peanuts, tree nuts, shellfish, insect venom and some medicines are most likely to send an allergic person into anaphylactic shock, any food can provoke a lethal reaction if the immune system reacts strongly enough to it, doctors warn.
Unlike immunotherapy for respiratory allergies, food allergy treatment cannot use injections to administer doses of peanut molecules or other allergens because the Food and Drug Administration has deemed it too risky. Other administration methods, such as by mouth or through a skin patch, are in the clinical trial phase and can be used only as part of an existing research study.
“A lot of people read that oral immunotherapy works and say, ‘Oh, I’ll just go home and start feeding nuts to the kids,’ but that would be extremely dangerous,” asserts Dr. Jacqueline Moran of DuPage Medical Group. “The dosage amounts are literally microscopic and the patient has to be carefully monitored by medical professionals in case an adverse reaction occurs.”
Under some circumstances, feeding nuts to young children could help them avoid peanut allergies, according to a 2015 study published in the New England Journal of Medicine.
“Five years ago most pediatricians told parents of children with a genetic history of nut allergies to delay introducing peanuts until the children are two or three years old,” Shah notes. “The Leap and Leap On study found that early introduction to peanuts actually lowers the risk of high-risk children developing the allergy. Now the recommendation is to test the child at four months [to make sure the allergy isn’t already present], then let them try a small dose of peanuts.”
Other potential cures that have not yet progressed to human trials include creating antibodies that block the allergen antibodies; medicines that modify the immune system proteins that react to allergens; and hybridizing a peanut strain that doesn’t have the proteins most likely to trigger an allergic reaction.
“It’s entirely possible,” concludes Shah, “that we will see a cure for food allergies within our lifetime.”Edit Module